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He S, Xie L, Liu J, Zou L. Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study. BMC Pulm Med 2023; 23:202. [PMID: 37296389 DOI: 10.1186/s12890-023-02478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Single-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB. METHODS We conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ2 test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators. RESULTS The routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB. CONCLUSION SFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.
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Affiliation(s)
- Shuzhen He
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lihua Xie
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Jianming Liu
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lijun Zou
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
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Tang L, West J, Lee E, Kharidia K, Hasday S, Chambers T, Kokot N, Swanson M, O'Dell K. Open Bedside Tracheostomy: Safe and Cost Saving but Underutilized Nationally. Otolaryngol Head Neck Surg 2023; 168:188-195. [PMID: 35380905 DOI: 10.1177/01945998221091905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate open bedside tracheostomy (OBT) and compare it with open operating room (OR) tracheostomy and bedside percutaneous dilatational tracheostomy (PDT) in complications and cost. To determine the tracheostomy practice patterns of academic otolaryngology programs. STUDY DESIGN Retrospective cohort study and cross-sectional study. SETTING Public hospital and tertiary care hospital. METHODS Otolaryngology program directors were surveyed to determine their institutions' tracheostomy practice patterns and the factors preventing the implementation of open bedside tracheostomies. A retrospective chart review was done of tracheostomies performed at our institutions from 2009 to 2019 for prolonged mechanical ventilation. Complications, length of intubation, comorbidities, body mass index, demographics, mortality rates, and decannulation rates were recorded. A cost analysis between OBT and PDT was conducted. RESULTS Data from 802 patients were analyzed for 449 OBTs, 206 PDTs, and 147 open OR tracheostomies. Complication rates were low. PDTs were more likely to have perioperative tracheal bleeding (P = .028) and mucus plugging (P = .006). OBTs were performed on sicker patients with a higher Charlson Comorbidity Index than PDT and OR tracheostomies. The cost of OBT was less than that of PDT. The survey response rate of tracheostomy practice patterns was 46%. The otolaryngologists at the responding programs all conducted OR tracheostomies, while 52.7% did OBTs and 30.9% PDTs. CONCLUSION OBT can be done safely in patients with multiple comorbidities and has a cost that can be less than PDT. Despite these benefits, only 50% of academic institutions routinely performed OBT. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Liyang Tang
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jonathan West
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Esther Lee
- Western University of Health Sciences, Pomona, California, USA
| | - Khush Kharidia
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Steven Hasday
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tamara Chambers
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels Kokot
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark Swanson
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Karla O'Dell
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Slomka B, Duan S, Knapp TG, Lima N, Sontz R, Merchant JL, Sawyer TW. Design, fabrication, and preclinical testing of a miniaturized, multispectral, chip-on-tip, imaging probe for intraluminal fluorescence imaging of the gastrointestinal tract. Front Photon 2023; 3:1067651. [PMID: 37691859 PMCID: PMC10488317 DOI: 10.3389/fphot.2022.1067651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Gastrointestinal cancers continue to account for a disproportionately large percentage of annual cancer deaths in the US. Advancements in miniature imaging technology combined with a need for precise and thorough tumor detection in gastrointestinal cancer screenings fuel the demand for new, small-scale, and low-cost methods of localization and margin identification with improved accuracy. Here, we report the development of a miniaturized, chip-on-tip, multispectral, fluorescence imaging probe designed to port through a gastroscope working channel with the aim of detecting cancerous lesions in point-of-care endoscopy of the gastrointestinal lumen. Preclinical testing has confirmed fluorescence sensitivity and supports that this miniature probe can locate structures of interest via detection of fluorescence emission from exogenous contrast agents. This work demonstrates the design and preliminary performance evaluation of a miniaturized, single-use, chip-on-tip fluorescence imaging system, capable of detecting multiple fluorochromes, and devised for deployment via the accessory channel of a standard gastroscope.
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Affiliation(s)
- Bridget Slomka
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, United States
| | - Suzann Duan
- Department of Medicine, College of Medicine Tucson, University of Arizona, Tucson, AZ, United States
| | - Thomas G. Knapp
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, United States
| | - Natzem Lima
- Wyant College of Optical Sciences, University of Arizona, Tucson, Arizona, United States
| | - Ricky Sontz
- Department of Medicine, College of Medicine Tucson, University of Arizona, Tucson, AZ, United States
| | - Juanita L. Merchant
- Department of Medicine, College of Medicine Tucson, University of Arizona, Tucson, AZ, United States
| | - Travis W. Sawyer
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, United States
- Wyant College of Optical Sciences, University of Arizona, Tucson, Arizona, United States
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Andersen CØ, Travis H, Dehlholm-Lambertsen E, Russell R, Jørgensen EP. The Cost of Flexible Bronchoscopes: A Systematic Review and Meta-analysis. Pharmacoecon Open 2022; 6:787-797. [PMID: 35994238 PMCID: PMC9596653 DOI: 10.1007/s41669-022-00356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Until 2009, only reusable bronchoscopes were marketed, but the introduction and widespread adoption of single-use flexible bronchoscopes (SFBs) as an emerging technology has since accelerated. Several studies have described the costs of reusable flexible bronchoscopes (RFBs) and SFBs. This meta-analysis aimed to compile the current published evidence to analyse the cost of different scenarios using RFBs and SFBs. METHODS All published literature describing the cost of RFBs or SFBs was identified by searching PubMed, Embase and Google Scholar, limited to those between 1 January, 2009 and 6 November, 2020. Included studies should report the total cost of RFBs. Continuous data were extracted for relevant outcomes and analysed using RStudio® 4.0.3 as the standardised mean difference and standard error of the mean in a mixed-effects model. Risk of bias was assessed based on the reporting quality. RESULTS In the systematic literature review, 342 studies were initially identified, and 11 were included in the final analysis. The mean RFB procedure cost was $266 (standard error of the mean: 34), including capital investments, repairs and reprocessing costs of $91, $92 and $83, respectively. The mean SFB procedure cost was $289 (standard error of the mean: 10). The incremental cost was $23 (standard error of the mean: 33) and was not significant (p = 0.46). Because of the economy of scale, RFB is more likely to be cost minimising compared with SFB when performing 306 or 39 procedures per site or RFB, respectively. CONCLUSIONS In this study, we found no significant difference in the cost of use between RFBs and SFBs and a high risk of bias.
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Kanti SY, Csóka I, Adalbert L, Jójárt-Laczkovich O. Analysis of the renewed European Medical Device Regulations in the frame of the non - EU regulatory landscape during the COVID facilitated change. J Pharm Sci 2022; 111:2674-2686. [PMID: 35872025 DOI: 10.1016/j.xphs.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
The term "Medical devices" includes technology-based devices or articles, both basic and complex. Due to these types of variations, a strict, robust, transparent, and sustainable regulatory framework is required. In recent clinical practice, incidents including the breast implant and the hip replacement crisis have made it necessary to improve the regulatory and compliance approaches for the industry to ensure the manufacturing and distribution of safe and innovative MDs within the EU. In response to this, the EU revised the laws governing medical devices and in vitro diagnostics to align with the developments of the sector, address critical safety issues and support innovation. The new regulation (EU) 2017/745 on Medical Devices (MDR) is now applicable from May 26 2021 and the In Vitro Diagnostic Medical Devices Regulation (EU) 2017/746 will take effect from May 2022.In this review, we aim to provide an update on the new Medical Device Regulations in the context of the current medical needs of the world, and also to give a glimpse at the non-EU regulatory landscape. Finally, we take a look at the closed-system transfer devices (CSTD) and COVID facilitated changes promoting demand for continuous improvement and trends in the pharmaceutical and medical industry related areas.
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Affiliation(s)
- Sp Yamini Kanti
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary.
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Lívia Adalbert
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Orsolya Jójárt-Laczkovich
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
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Tariparast PA, Brockmann A, Hartwig R, Kluge S, Grensemann J. Percutaneous dilatational tracheostomy with single use bronchoscopes versus reusable bronchoscopes – a prospective randomized trial (TraSUB). BMC Anesthesiol 2022; 22. [PMID: 35366806 PMCID: PMC8976163 DOI: 10.1186/s12871-022-01618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Apart from conventional reusable bronchoscopes, single-use bronchoscopes (SUB) were recently introduced. Data suggest that SUB might prevent from the risk of cross contamination (i.e. multiresistant pathogens, SARS CoV-2) and save costs. We aimed to investigate visualization, ventilation, handling characteristics, changes in patients’ gas exchange, and costs associated with both types of bronchoscopes during percutaneous dilatational tracheostomy (PDT). Methods In this prospective, randomized, noninferiority study, 46 patients undergoing PDT were randomized 1:1 to PDT with SUB (Ambu aScope) or reusable bronchoscopes (CONV, Olympus BF-P60). Visualization of tracheal structures rated on 4-point Likert scales was the primary end-point. Furthermore, quality of ventilation, device handling characteristics, changes in the patients’ gas exchange, pH values, and costs were assessed. Results Noninferiority for visualization (the primary endpoint) was demonstrated for the SUB group. Mean visualization scores (lower values better) were 4.1 (95% confidence intervals: 3.9;4.3) for SUB vs. 4.1 (4.0;4.2) for CONV. Noninferiority of ventilation (estimated by minute volume and SpO2) during the procedure could be shown as well. Mean score was 2.6 (2.0;3.1) for SUB vs. 2.4 (2.1;2.7) for CONV (lower values better). No significant differences regarding handling (SUB: 1.2 (1.0;1.4), CONV: 1.3 (1.1;1.6)), blood gas analyses and respiratory variables were found. Cost analysis in our institution revealed 93 € per conventional bronchoscopy versus 232.50 € with SUB, not considering an estimate for possible infection due to cross-contamination with the reusable device. Conclusion In our study, visualization and overall performance of the SUB during PDT were noninferior to reusable bronchoscopes. Therefore, PDT with SUB is feasible and should be considered if favored by individual institution’s cost analysis. Trial registration. ClinicalTrials.gov, NCT03952247. Submitted for registration on 28/04/2019 and first posted on 16/05/2019.
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Ho E, Wagh A, Hogarth K, Murgu S. Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine. Diagnostics (Basel) 2022; 12:174. [PMID: 35054345 PMCID: PMC8775174 DOI: 10.3390/diagnostics12010174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.
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Affiliation(s)
- Elliot Ho
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Ajay Wagh
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
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Klemeš JJ, Fan YV, Jiang P. The energy and environmental footprints of COVID-19 fighting measures - PPE, disinfection, supply chains. Energy (Oxf) 2020; 211:118701. [PMID: 32868962 PMCID: PMC7450254 DOI: 10.1016/j.energy.2020.118701] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 05/18/2023]
Abstract
The still escalating COVID-19 pandemic also has a substantial impact on energy structure, requirements and related emissions. The consumption is unavoidable and receives a lower priority in the critical situation. However, as the pandemic continues, the impacts on energy and environment should be assessed and possibly reduced. This study aims to provide an overview of invested energy sources and environmental footprints in fighting the COVID-19. The required energy and resources consumption of Personal Protection Equipment (PPE) and testing kits have been discussed. The protecting efficiency returned on environmental footprint invested for masks has been further explored. The main observation pinpointed is that with a proper design standard, material selection and user guideline, reusable PPE could be an effective option with lower energy consumption/environmental footprint. Additional escalated energy consumption for aseptic and disinfection has been assessed. This includes the energy stemming from emergency and later managed supply chains. The outcomes emphasised that diversifying solutions to achieve the needed objective is a vital strategy to improve the susceptibility and provide higher flexibility in minimising the environmental footprints. However, more comprehensive research proof for the alternative solution (e.g. reusable option) towards low energy consumption without compromise on the effectiveness should be offered and advocated.
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Affiliation(s)
- Jiří Jaromír Klemeš
- Sustainable Process Integration Laboratory - SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology - VUT Brno, Technická 2896/2, 616 69, Brno, Czech Republic
| | - Yee Van Fan
- Sustainable Process Integration Laboratory - SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology - VUT Brno, Technická 2896/2, 616 69, Brno, Czech Republic
| | - Peng Jiang
- Department of Systems Science, Institute of High Performance Computing, Agency for Science, Technology and Research (A∗STAR), Singapore, 138632, Singapore
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Bouthors C, Nguyen J, Durand L, Dubory A, Raspaud S, Court C. Single-use versus reusable medical devices in spinal fusion surgery: a hospital micro-costing analysis. Eur J Orthop Surg Traumatol 2019; 29:1631-1637. [PMID: 31350650 DOI: 10.1007/s00590-019-02517-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Healthcare facilities could minimize the cost of surgical instrument and implant processing by using single-use devices. The main objective was to prospectively compare the total cost of a single-use and reusable device used in short lumbar spine fusion. METHODS A 1-year, single-centre, prospective study was performed on patients requiring a one- or two-level lumbar arthrodesis. Patients were randomized in two groups treated with either reusable or single-use device. A cost minimization analysis was performed using a micro-costing approach from a hospital perspective. Every step of the preparation process was timed and costed based on hourly wages of hospital employees, cleaning supplies and hospital waste costs. RESULTS Forty cases were evaluated. No significant difference in operation time was noted (reusable 176.1 ± 68.4 min; single use 190.4 ± 71.7 min; p = 0.569). Mean processing time for single-use devices was lower than for reusable devices (33 min vs. 176 min) representing a cost of 14€ versus 58€ (p < 0.05). Pre-/post-sterilization and spinal set recomposing steps were the most time-consuming in reusable device group. A total cost saving of 181€ per intervention resulted from the use and processing of the single-use device considering an additional sterilization cost of 137€ with the reusable device. The weight of the reusable device was 42 kg for three containers and 1.2 kg for the single-use device. CONCLUSIONS Owing to the absence of re-sterilization, single-use devices in one- and two-level lumbar fusion allow significant money and time savings. They may also avoid delaying surgery in case of reusable device unavailability.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - J Nguyen
- Pharmacy and Sterilization Department, Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - L Durand
- Pharmacy and Sterilization Department, Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - A Dubory
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - S Raspaud
- Pharmacy and Sterilization Department, Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - Ch Court
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
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